Surgery for Ankylosing Spondylitis: When Is It Necessary?

Following your treatment regimen can prevent the need for these complex surgeries.

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When you hear that your arthritis may one day require surgery, it’s natural to be concerned. Luckily, the majority of patients will never need surgery for ankylosing spondylitis (AS), according to Anca D. Askanase, MD, MPH, rheumatologist at Columbia University Irving Medical Center.

“Surgery is for the treatment failures. Surgery is for the time when all else failed. It's for the time when we were unable to control the disease,” says Dr. Askanase.

There are many ways to prevent complications of AS. In particular, following your treatment regiment can keep inflammation and spinal damage at bay. For people who do have complications—such as spinal fusion—surgery is available to help.

Surgeries for the Spine

There are two types of surgery for ankylosing spondylitis: cervical fusion and corrective wedge osteotomy.

Cervical fusion is used for patients who have fractures in the spine. In this procedure, your surgeon will intentionally fuse some vertebrae together. Typically, the goal of this surgery is to prevent damage to the spinal cord.

Corrective wedge osteotomy is a surgery for treating spinal fusion, particularly when it’s in a hunched-over position. In this procedure, your surgeon removes small wedges of the fused spine. Then, the surgeon fixes the spine into a better, more natural position.

“Spine surgery is not simple surgery. They are complicated, complex, long surgeries,” says Dr. Askanase. “They should be done in a center that specializes in spine surgery, where the surgeons are versed in these procedures.”

Surgeries for the Hip

In some cases, people with AS may require hip surgery. Although AS primarily affects the spine, many patients do experience inflammation in the hips that causes pain and limited mobility. When this occurs, doctors may recommend a total hip replacement.

“Hip replacements are not as big of a surgery as a spine surgery, but they are several hours' worth of surgery where both parts of the hip are now replaced with metal components that now allow for good mobility,” says Dr. Askanase.

Avoiding Surgery

Luckily, surgery for AS isn’t that common. “Most people will never have surgery. Following the medication regimen [and] lifestyle changes are very good preventive measures to the need for surgery,” says Dr. Askanase.

That’s why it’s so important to see your doctor for a diagnosis and treatment early. That way, you can start medications for AS, learn the recommended lifestyle modifications, and develop a routine that works for you and your body.